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Archive for January, 2009

http://www.ncbi.nlm.nih.gov/pubmed/18563775

Lasers Surg Med. 2008 Jul;40(5):293-9.

Long-pulsed dye laser versus intense pulsed light for photodamaged skin: a randomized split-face trial with blinded response evaluation.

Jørgensen GF, Hedelund L, Haedersdal M.

Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

 

 

In this paper, Gitte Jørgensen reports a rarely seen type of study in the aesthetic space – a randomied comparison of two competing device technologies.  The study was co-sponsored by both device manufacturers, but neither manufacturer participated in the conduct or analysis of the study.  Most aesthetic device studies compare a device treatment to an untreated control, to show that the treatment causes some effect.  In contrast, this study compared the Candela VBeam Perfecta (long pulse 595nm dye laser) with the Ellipse Flex (Intense Pulsed Light) for the treatment of photodamaged skin, to see if the treatments caused different outcomes

The study was well-designed to demonstrate the differences with each type of treatment.  First, the patient population was homogenous (light skin females).  Reduction of patient variability reduces confounding of outcomes and enables smaller sample sizes.  Second, each study participant received a series of 3 split-face treatments with the one side randomized to each device type, which properly controls for non-study effects (e.g. additional sun exposure).  The use of the series of 3 treatments would magnify outcome differences, if there were any.  Third, the evaluation was performed on-site by a blinded, independent physician, to prevent bias and to prevent the introduction of photographic artifact.  Although blinding adequately prevents bias, agreement from multiple blinded observers would be useful to reduce individual subjectivity in the assessment of improvement.

While both devices demonstrated improved outcomes in this study, the long pulse 595nm dye laser achieved overall superior results, due to superior performance on vascular lesions.  Fourteen of 20 patients obtained better clearing of telangiectasias with the pulsed dye laser and the remainder saw no difference.  The difference in lightening was both statistically and clinically significant (i.e. the difference in lightening was visually apparent to the blinded reviewer and the patient). Both devices achieved similar improvements for irregular pigmentation and skin texture.  Neither device showed any improvement in wrinkles/rhytids.  Eighteen of 20 patients preferred the pulsed dye laser, both because of improved vascular clearance and because there was less treatment-related pain.

Despite an excellent study design, there are some limitations to the study conclusions.  The superior results of the pulse dye laser should not be considered definitive, as there was no-pre-defined study hypothesis to be proven.  The study was too small to determine whether there was a significant difference in the rates of adverse effects between the two devices.  Because both devices demonstrated improvement in outcomes, practitioners may be able to achieve pulsed-dye-laser results by simply performing additional IPL treatments.  Possibly, other IPL systems may perform better than the Ellipse product used in this study.

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  • Filed under: Device Review, MedSpa
  • A combination of topical solution (Levulan made by DUSA Pharmaceuticals Inc.) and pulsed dye laser treatment—that stimulates collagen production and can help rejuvenate skin that has been overexposed and sun-damaged. U.S. physicians use the photodynamic therapy to improve the appearance of skin with wrinkles, sun spots, and fine lines. 

    A team of U.S. researchers from the University of Michigan recently studied a group that consisted of 10 men and 15 women between the ages of 54 and 83 that had skin that was sun-damaged, and found that the therapy did increase the production of collagen, a protein that helps provide skin its elasticity and texture, and promoted the thickening of the top layer of skin. The team performed this procedure on the sun-damaged skin of the forearm of the 25 volunteers and took samples of the tissue to examine the changes in the skin. The collagen production was twice as great with Levulan with the laser treatment compared to just the laser treatment alone.

    Dr. Jeffrey Orringer, the director of the University of Michigan’s Cosmetic Dermatology and Laser center stated, “We do believe that the treatment would, in fact, improve the appearance of patients’ skin…. It lends molecular or scientific credibility to a procedure that’s being done out there, and it’s also the first step in understanding how to make this treatment more effective.” Orringer also said that there was no industry money used to fund this study, which was published in the Archives of Dermatology.

    Many people today are eager to improve the appearance of their skin, damaged by years of sunbathing or other types of exposure to the sun. Photodynamic therapy is currently being performed, often to the face, and can cost hundreds of dollars per treatment session. The U.S. Food and Drug Administrations approved Levulan in 1999 to help with the treatment of precancerous skin lesions either on the face or scalp called actinic keratoses. It is also being used “off-label” in the photodynamic therapy to help make sun-damaged skin approve its appearance.

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  • Filed under: LT | pigmented lesions
  • In the Western world, more than 10% of the population have at least 1 tattoo. If the tattoo is removed, the tattoo pigment particles in the skin can be selectively destroyed by means of selective photothermolysis by different types of medical aesthetic lasers. This treatment requires laser pulses of short durations (nanoseconds) and high intensities (fluenses).

    Dr. Wolfgang Bäumler, Department of Dermatology, University of Regensburg in Germany reports on 12 patients who received treatments with improper treatment parameters. In all patients, his group diagnosed hypo- or hyperpigmentations and scar formation at the treatment site. In particular, the pulse duration of the light sources or lasers applied were considerably longer than those required by the principles of selective photothermolysis. The light intensities of those devices are normally not sufficient to destroy the pigment particles. Instead of destruction, the pigment particles in the skin are heated up and the heat is conducted to the adjacent tissue causing unspecific tissue injury.

    CONCLUSION

    Lasers and especially intense pulsed light sources with more than 1 millisecond pulses and low light intensities are clearly not suitable to be applied for laser tattoo removal.

    Dr Vijay Sharma, the President of the Indian Association of Cosmetic Surgeryand Dr. Kiran Naik of the Chicago Cosmetic Surgery Centre have independently stated that Botox — the biggest fad in cosmetic procedures — is also “the biggest fraud”. The injectible contains bacteria that paralyses muscles on being injected into the skin, giving a ‘youthful’ wrinkle-free appearance.

    But because the effect of Botox is temporary, regular touch-ups are essential. “In the case of frequent use, the damage to the muscles may force a patient to undergo a face-lift at an early age. This scam allows for doctors and dermatologists to set themselves up for a steady income from their patients.” warns Sharma.

    It goes without saying that the glamour business is the biggest hunting ground for cosmetic surgeons. In their ceaseless quest to look picture perfect, many top movie stars have undergone “beautification’ surgeries”, often with nasty complications, but preferred to remain tight-lipped.

    Long term Botox complications are still understudied, but these opinions are hard to ignore. It is quite likely that heavy users of Botox will come back for a more serious surgical treatment, which, of course, will be available at a price. Those voluptuous lips many movie stars are carrying around are a part of their backsides. With age the latter resource will be useful for the Botox repair.

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  • Filed under: Dermal Fillers
  • Any physician can’t but notice a significant increase in non-invasive and non-surgical procedures.

    The job market is very competitive, and people are scared. With the combination of financing, decreased pricing and a wider range of services available, it becomes very realistic to give yourself a boost, go into that interview with an edge and just feel good all around. Procedures such as a photorejuvenation, injectable fillers takes a few minutes, zero down-time, produce quick or almost immediate results and cost a fraction of what a surgical face lift would be. Lasers, Botox and fillers can accomplish a very broad range of results from simply filling in the little lines around your mouth, to a completely different look.

    More and more aesthetic practices offer financing with programs that range from interest free to 48 month extended plans.

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  • Filed under: Market | businesses, Market | consumers
  • Many patients who undergo cosmetic and plastic surgery procedures experience significant scarring from the incisions. Procedures such as the tummy tuck, breast augmentation and facelift surgery typically leave behind large, noticeable scars that are difficult to cover up with makeup. Scars can take weeks, months and even years to heal completely and there are a number of topical scar gels and creams available to reduce the appearance of the traumatized skin.

    However, results from a recent study completed at the Cosmetic Surgery and Skin Health Center at the University of Pittsburgh Medical Center (UPMC) in Pittsburgh indicate that laser therapy may be used as an early intervention plan for scar formation. Lasers can be used to stop the growth of scars by delivering high-energy waves to the skin and lightening any discoloration on the traumatized skin. Pulse-dyed lasers and fractionated lasers have been the most effective at reducing the appearance of scars after surgery so far, and lasers such as Fraxel may even help reduce the appearance of mature scars

    Dr. Suzan Obagi, assistant clinical profesor of dermatology at UPMC explains that the best time to treat scars with this type of therpay is right when the sutures are removed. This helps reduce the risk of dark scar formation, and may also speed up the body’s natural healing process. Increasing collagen and elastin production helps the skin recover rapidly and restore itself to its natural state.

    Younger patients tend to heal faster than older patients regardless of the type of treatment used, and overall health and diet also play a role in wound healing and scar development. Individuals who are deficient in vitamins and proteins may not be able to heal as fast or as effectively; however, laser therapy may help to reduce the risk of deep scar formation and improve the healing process overall. (Source: ModernMedicine.com)

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  • Filed under: LT | scars
  • Weathering the Storm

    podcastweathering-the-storm

    Cosmetic facial surgeon Joseph Niamtu, III, D.M.D., F.A.A.C.S. says there are several things that cosmetic surgeons can do to ride out this economic storm.

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